伽玛刀放射外科治疗49例颅咽管瘤的临床效果分析
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摘要
目的:探讨伽玛刀放射外科治疗颅咽管瘤的临床效果和预后。方法:回顾性分析49例颅咽管瘤患者的临床资料,均给予伽玛刀放射外科治疗,肿瘤平均体积为2.75 cm~3,边缘平均剂量为11.8 Gy。临床效果通过磁共振检查、神经内分泌学和下丘脑症状、并发症和KPS评分评价。结果:49例患者影像学检查,16例完全缓解,20例部分缓解,9例无变化,4例肿瘤进展。肿瘤反应率为69.4%,控制率为87.8%。使用11.8 Gy的边缘剂量治疗较小的颅咽管瘤,有更好的控制率且没有并发症发生。KPS评分100分24例, 90分16例,70～80分4例,50～60分2例。Kaplan-Meier生存分析表明5年生存率为95.9%,10年生存率为87.8%。5年肿瘤无进展生存率为77.6%,10年肿瘤无进展生存率为73.5%。3例患者因肿瘤进展死亡。结论:在显微手术联合放射治疗后,肿瘤体积的减小和有效的放射剂量设定对于改善患者生活质量和生存至关重要。
Objective:To evaluate outcome and prognosis of craniopharyngioma treated by Gamma knife radiosurgery.Methods:Clinical data of 49 cases of craniopharyngioma were analyzed retrospectively,which were all treated by Gamma knife radiosurgery.The mean volume of craniopharyngioma was 2.75 cm~3 and the mean marginal dose was 11.8 Gy.The outcomes were assessed by MRI,neuro-endocrine and hypothalamic symptoms,coaplications and KPS scores.Results:Complete remission was in 16,partial remission was in 20,no change in 9 and progression in 4 patients.Tumor response was 69.4% and tumor control rate was 87.8%.Marginal dose of 11.8 Gy was used to a smaller tumor and better control rate without complications was obtained.KPS was excellent in 24,good in 16,fair in 4 and poor in 2.Kaplan-Meier curves showed 5-year survival rate was 95.9% and 10-year survival rate was 87.8%.Progression-free survival was 77.6% at 5 years and 73.5% at 10 years,respectively.Three cases died of tumor progression.Conclusion:Reduction of tumor volume and effective dose setting will be important for the improvement of quality of life and survival after microsurgery combined with radiosurgery of craniopharyngioma.
Objective:To evaluate outcome and prognosis of craniopharyngioma treated by Gamma knife radiosurgery.Methods:Clinical data of 49 cases of craniopharyngioma were analyzed retrospectively,which were all treated by Gamma knife radiosurgery.The mean volume of craniopharyngioma was 2.75 cm~3 and the mean marginal dose was 11.8 Gy.The outcomes were assessed by MRI,neuro-endocrine and hypothalamic symptoms,coaplications and KPS scores.Results:Complete remission was in 16,partial remission was in 20,no change in 9 and progression in 4 patients.Tumor response was 69.4% and tumor control rate was 87.8%.Marginal dose of 11.8 Gy was used to a smaller tumor and better control rate without complications was obtained.KPS was excellent in 24,good in 16,fair in 4 and poor in 2.Kaplan-Meier curves showed 5-year survival rate was 95.9% and 10-year survival rate was 87.8%.Progression-free survival was 77.6% at 5 years and 73.5% at 10 years,respectively.Three cases died of tumor progression.Conclusion:Reduction of tumor volume and effective dose setting will be important for the improvement of quality of life and survival after microsurgery combined with radiosurgery of craniopharyngioma.
引文
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[12] Kobayashi T,Kida Y,Mori Y,et al.Long-term results of gamma knife surgery for the treatment of craniopharyngioma in 98 consecutive cases[J].J Neurosurg (6 Suppl Pediatr),2005,103(6 Suppl):482-488.
[13] Chiou SM,Lunsford LD,Niranjan A,et al.Stereotactic radiosurgery of residual or recurrent craniopharyngioma,after surgery,with or without radiation therapy[J].Neurooncol,2001,3(3):159-166.
[14] Savateev AN,Trunin YY,Mazerkina NA.Radiotherapy and radiosurgery in treatment of craniopharyngiomas[J].Zh Vopr Neirokhir Im N N Burdenko,2017,81(3):94-106.
[15] Mazerkina NA,Savateev AN,Gorelyshev SK,et al.Transient enlargement of craniopharyngioma cysts after stereotactic radiotherapy and radiosurgery[J].Zh Vopr Neirokhir Im N N Burdenko,2017,81(6):40-47.
[2] Astradsson A,Munck Af Rosensch?ld P,Feldt-Rasmussen U,et al.Visual outcome,endocrine function and tumor control after fractionated stereotactic radiation therapy of craniopharyngiomas in adults:findings in a prospective cohort[J].Acta Oncol,2017,56(3):415-421.
[3] Maarouf M,Majdoub FE,Fuetsch M,et al.Stereotactic intracavitary brachytherapy with P-32 for cystic craniopharyngiomas in children[J].Strahlenther Onkol,2016,192(3):157-165.
[4] Rachinger W,Oehlschlaegel F,Kunz M,et al.Cystic craniopharyngiomas:Microsurgical or stereotactic treatment[J]?Neurosurgery,2017,80(5):733-743.
[5] Kobayashi T,Tsugawa T,Hatano M,et al.Gamma knife radiosurgery of craniopharyngioma:Results of 30 cases treated at Nagoya Radiosurgery Center[J].Nagoya J Med Sci,2015,77(3):447-454.
[6] Xu Z,Yen CP,Schlesinger D,et al.Outcome of Gamma Knife radiosurgery for craniopharyngioma[J].J Neurooncol,2011,104(1):305-313.
[7] Kobayashi T,Mori Y,Tsugawa T,et al.Prognostic factors for tumor recurrence after gamma knife radiosurgery of partially resected and recurrent craniopharyngioma[J].Nagoya J Med Sci,2012,74(1-2):141-147.
[8] Preece D,Allan A,Becerra R.A case study of the neuropsychological outcomes following microsurgery,conventional radiotherapy and stereotactic radiotherapy for an adult's recurrent craniopharyngioma[J].Brain Inj,2016,30(1):104-111.
[9] Graffeo CS,Perry A,Link MJ,et al.Pediatric craniopharyngiomas:A primer for the skull base surgeon[J].J Neurol Surg B Skull Base,2018,79(1):65-80.
[10] Takano S,Akutsu H,Mizumoto M,et al.Neuroendoscopy followed by radiotherapy in cystic craniopharyngiomas-a long-term follow-up[J].World Neurosurg,2015,84(5):1305-1315.e1-2.
[11] Harrabi SB,Adeberg S,Welzel T,et al.Long term results after fractionated stereotactic radiotherapy (FSRT) in patients with craniopharyngioma:Maximal tumor control with minimal side effects[J].Radiat Oncol,2014,9:203.
[12] Kobayashi T,Kida Y,Mori Y,et al.Long-term results of gamma knife surgery for the treatment of craniopharyngioma in 98 consecutive cases[J].J Neurosurg (6 Suppl Pediatr),2005,103(6 Suppl):482-488.
[13] Chiou SM,Lunsford LD,Niranjan A,et al.Stereotactic radiosurgery of residual or recurrent craniopharyngioma,after surgery,with or without radiation therapy[J].Neurooncol,2001,3(3):159-166.
[14] Savateev AN,Trunin YY,Mazerkina NA.Radiotherapy and radiosurgery in treatment of craniopharyngiomas[J].Zh Vopr Neirokhir Im N N Burdenko,2017,81(3):94-106.
[15] Mazerkina NA,Savateev AN,Gorelyshev SK,et al.Transient enlargement of craniopharyngioma cysts after stereotactic radiotherapy and radiosurgery[J].Zh Vopr Neirokhir Im N N Burdenko,2017,81(6):40-47.
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